Alarm routing optimization strategies in targeted alarm system

ABSTRACT

A targeted alarm system is described that includes a network probe for sending test data to terminal devices connected to a network and deriving reliability data of the terminal devices and the network. When a targeted alarm message needs to be sent, the system identifies a targeted terminal device based on the reliability data for sending the targeted alarm message. Related methods, apparatus, and non-transitory computer readable media are also disclosed.

The present application is a 35 USC § 371 national stage application ofInternational Application No. PCT/US2014/071294, filed Dec. 18, 2014,the entirety of which is incorporated herein by reference.

TECHNICAL FIELD

The subject matter described herein relates to alarm routing monitoringand optimization strategies in a targeted medical alarm system.

BACKGROUND

In a distributed targeted alarm system, there is risk of alarm messagedelivery failure or delay, which could be harmful to the patient.Delivery failure or delay can emerge at the level of systemsintegration. Even if individual monitoring hardware and software areperfect, timely deliveries of alarm messages will depend (at leastpartly) on, for example, the hospital's network infrastructure. Anotherfactor that could cause delivery failure or delay is the terminaldevices carried by caregivers that will receive the alarm messages(e.g., iPhones, Android phones, pagers). Different network devices andeven caregivers may have different reliability characteristics. Forexample, a central station hard-wired over Ethernet will likely have avery reliable network connection, while a mobile wireless device may beless reliable. Furthermore, a mobile device connected over a wide areacellular network will have much greater latency than one connecteddirectly to the hospital's internet network. These different possibleconditions can create uncertainty in alarm message delivery.

SUMMARY

Variations of the present subject matter are directed to methods,systems, devices, and other articles of manufacture that are provided toalarm routing monitoring and optimization strategies in a targetedmedical alarm system.

The present subject matter provides a targeted medical alarm system thatincludes a network adapter configured to communicate with a plurality ofterminal devices over one or more networks. Each of the terminal devicesis associated with a respective caregiver. The system also includes oneor more data processors and a computer-readable medium storinginstructions that when executed by the one or more data processors,performs operations that include sending test data to each of theterminal devices. The operations also include receiving acknowledgementdata indicating when the test data was received by the respectiveterminal device, and determining one or more latency-related valuesassociated with each of the test data and the acknowledgement data;updating reliability data based at least in part on the latency-relatedvalues. Based at least in part on the reliability data, a targetedterminal device to which a targeted message is to be sent is identified.

One or more of the following features can be included in any feasiblecombination. For example, in some variations, the test data comprise oneor more test packets. In some variations, the test data is sentperiodically. In some variations, the reliability data comprise areliability map.

In some variations, the operations can also include one or more of:sending the targeted message to the targeted terminal device; receivingone or more response messages generated by each of the terminal devices,and generating one or more statistics for each of the terminal devicesbased on the one or more response messages; and identifying a secondaryterminal device based at least in part on the reliability data andsending the targeted message to the secondary terminal device.

In some variations, the one or more latency-related values include oneor more of: a success or failure of acknowledgement, round-trip messagelatency, a message routing path, and a physical location.

In some variations, the reliability data include one or more of: acurrent workload data for at least some of the caregivers and theassociated terminal devices; a proximity data for at least some of thecaregivers and the associated terminal devices; an energy level data forat least some of the caregivers and the associated terminal devices; ahistorical response data for at least some of the caregivers; and aphysical distribution of the caregivers and the associated terminaldevices.

In some variations, the one or more statistics include one or more of: aresponse time, a current location, a typical location, a scheduledactivity, and a scheduled location.

In some variations, the targeted terminal device is determined based atleast in part on the one or more statistics of each of the terminaldevices.

In some variations, the secondary terminal device is identified for eachcritical message.

In some variations, the server is further configured to generate areport of the reliability data.

In some variations, the targeted device is determined based at east inpart on a location distribution of the terminal devices.

In some variations, each of the latency-related values are weighed andcombined to generate an overall reliability and latency of each of theterminal devices.

In some variations, the system further includes one or more of theplurality of terminal devices. Each of the terminal devices isconfigured to generate the acknowledgement data upon receipt of the testdata.

The present subject matter also provides a method of targeted medicalalarm for implementation by one or more data processors forming part ofa least one computing device. The method includes transmitting, by atleast one data processor, test data to each of a plurality of terminaldevices, and receiving, by at least one data processor, an automaticacknowledgement from each of the terminal devices indicating when thetest data were received. Based on the automatic acknowledgement, one ormore latency-related values associated with the test data are determined(by at least one data processor), and reliability data based at least inpart on the latency-related values are updated. The method also includesidentifying, by at least one data processor and based on the reliabilitydata, a terminal device to which a targeted message is to be sent.

One or more of the following features can be included in any feasiblecombination. For example, in some variations, the test data comprisesone or more test packets.

In some variations, the test data is transmitted periodically.

In some variations, the reliability data includes one of more of: areliability map; a current workload data for at least some of thecaregivers and the associated terminal devices; a proximity data for atleast some of the caregivers and the associated terminal devices; anenergy level data for at least some of the caregivers and the associatedterminal devices; a historical response data for at least sonic of thecaregivers; and a physical distribution of the caregivers and theassociated terminal devices.

In some variations, the method further includes sending the targetedmessage to the targeted terminal device.

In some variations, the one or more latency-related values include oneor more of: a success or failure of acknowledgement, round-trip messagelatency, a message routing path, and a physical location.

In some variations, the method further includes receiving, by at leastone data processor, a response message from a responsive terminaldevice; and generating, by at least one data processor, one or morestatistics of the responsive terminal device based on the responsemessage.

In some variations, the one or more statistics include one or more of: aresponse time, a current location, a typical location, a scheduledactivity, and a scheduled location.

In some variations, the targeted device is determined based at east inpart on the one or more statistics of each of the terminal devices.

In some variations, the method further includes identifying, by at leastone data processor, a secondary terminal device based at least in parton the reliability data; and sending, by at least one data processor,the targeted message to the secondary terminal device.

In some variations, the secondary terminal device is identified for eachcritical message.

In some variations, the method further includes generating, by at leastone processor, a report of the reliability data.

In some variations, the targeted device is determined based at least inpart on a location distribution of the terminal devices.

In some variations, the method further includes weighing and combining,by one or more data processor, each of the latency-related values togenerate an overall reliability and latency of each of the terminaldevices.

In some variations, the method further includes generating the automaticacknowledgement from each of the terminal devices upon receipt of testdata.

Non-transitory computer program products (i.e., physically embodiedcomputer program products) are also described that store instructions,which when executed by one or more data processors of one or morecomputing systems, causes at least one data processor to performoperations herein. Similarly, computer systems are also described thatmay include one or more data processors and memory coupled to the one ormore data processors. The memory may temporarily or permanently storeinstructions that cause at least one processor to perform one or more ofthe operations described herein. In addition, methods can be implementedby one or more data processors either within a single computing systemor distributed among two or more computing systems. Such computingsystems can be connected and can exchange data and/or commands or otherinstructions or the like via one or more connections, including but notlimited to a connection over a network (e.g. the Internet, a wirelesswide area network, a local area network, a wide area network, a wirednetwork, or, the like), via a direct connection between one or more ofthe multiple computing systems, etc.

The subject matter described herein provides many advantages. Forexample, by providing a system and method that can determine (a) howlong it will take for an alarm message to reach a caregiver, and howlong will it take that caregiver to respond, (b) the uncertainty in themessage latency and caregiver response time, and (c) how a targetedalarm system can mitigate this uncertainty when transmittinglife-critical and/or time-critical alarm messages, alarm messagedelivery failures and delays can be reduced.

BRIEF DESCRIPTION OF THE FIGURES

FIG. 1 is a diagrammatic illustration of an example of an environment inaccordance with the current subject matter;

FIG. 2 is a diagrammatic illustration of a system in accordance withsome variations of the current subject matter;

FIGS. 3-5 are graphs showing examples of the latency distribution, andprobability distributions; and

FIG. 6 shows an example of process flow in accordance with somevariations of the current subject matter.

DESCRIPTION

FIG. 1 is a diagrammatic illustration of an example of an environmentfor implementing alarm routing monitoring, and optimization. Here, atargeted medical alarm system 110 is in data communication with terminaldevices 131,132, and 133 via one or more of cellular networks 161, 162,163, and WiFi network 151. The terminal devices are each associated witha respective caregiver, who are caring for one or more patients inroom/bed 142-149. The caregiver associated with terminal device 131 isattending to the patient in room/bed 142 while the caregiver associatedwith terminal device 132 is attending to the patient in room/bed 147.The caregiver associated with terminal device 133 is at the caregivercentral station 121, which can be provided with an alarm display system(e.g., connected to a local computer network through a hard-wired dataconnection like Ethernet). Another alarm display system 171 is alsoprovided in a common area (e.g., in a hallway). The alarm display system171 can also be connected to the local computer network through ahard-wired data connection like Ethernet, or a wireless datacommunication (e.g., over WiFi network 151).

FIG. 2 is a diagrammatic illustration of system 110 in accordance withsome variations of the current subject matter. In this example, system110 includes one or more processors 111, memory 112, and network adapter113. Network adapter 113 is configured to communicate with a pluralityof terminal devices (e.g., 131-133). System 110 is in data communicationwith data storage 210 (e.g., for storing one or more databasescontaining various data relating to the terminal devices, networks,etc.) via data connection 201. System 110 can also include, for example,input devices such as a keyboard, mouse, and the like, and outputdevices such as speakers, display, printer, and the like. In somevariations, data storage 210 car be implemented as part of the system.Memory 112 and/or storage 210 can include instructions that perform oneor more features discussed in this application when executed by one ormore processors 111.

In some variations, system 110 can be configured to continuously(automatically) measure network conditions to estimate the reliabilityof different terminal devices on different branches of the network. Forexample, terminal device 131 can be connected to cellular network 161,(e.g., a 2G cellular network, through a first provider), terminal device132 is connected to cellular network 162 (e.g., a 3G cellular network,through a second provider) and WiFi network 151, and terminal device 133is connected to cellular network 163 (e.g., a 4G cellular network,through a third provider), and system 110 can be configured to monitorand measure network conditions over each cellular network 161-163 andWiFi network 151,

In some variations, system 110 can include a network probe configured tosend test data to each of the various terminal devices connected to thenetworks. In some variations, the test data can include test packets,which can be sent, for example, periodically.

In some variations, the terminal devices can be configured toautomatically acknowledge receipt of the test data just as they wouldfor an actual alarm message (this can be done, for example, withoutdisturbing the caregiver). The network probe can be configured to logone or more result data including, for example: success or failure ofacknowledgement, round-trip message latency, message routing path, andpossibility physical location of the terminal device in space.

In some variations, the selection of the target terminal device and/orthe time of message could be randomized and/or staggered so as not tooverload the network. In some variations, samples are taken frequentlyenough to gather information with sufficient resolution over time andspace. In some variations, after enough samples have been collected, theprobe can derive a reliability map of the network. In some variations,the reliability map can be a data set that includes (for example) datarepresenting the reliability of sub-networks, links, and other networkcomponents of which the network is comprised. In such a map, somesub-networks and links can be highly reliable and have low latency,while others will be less reliable and have higher latency. Reliabilityconditions can change over time as network channel and loadingconditions change, so in some variations, the map can be (and should be)continuously dynamically updated.

The current subject matter also provides, in some variations, a systemconfigured to predict alarm message latency based on network reliabilitymeasurements. In some variations, network reliability can be representedas a graph of probability distributions. In some variations, graph nodescare, for example, represent the terminal devices, and links betweennodes can, for example, represent the network infrastructure. Thenetwork probe can be configured to find nodes and links to have certainprobability distributions of latency (in the event of failure, infinitelatency). In some variations, the targeted alarm system can beconfigured to estimate the total latency, for example, by combining thelatency distributions through the graph. The result would beprobabilistic, represented, for example, by a random variable with aprobability distribution. Statistics could be calculated from the randomvariable, including, for example, one or more of: mean, median, mode,variance, skew, kurtosis, and higher order measures of uncertainty.

References will be made now to FIGS. 3-5, which show examples of thelatency distribution, and probability distributions. These figures areprovided for illustrative purposes only, and do not limit the currentsubject matter.

FIG. 3 shows an example of how a large collection of latency samples canbe used to estimate a probability distribution. The system can beconfigured to sample a device's latency periodically and records thevalue. As the values are collected, they can be represented in ahistogram (the histogram shown in FIG. 3 is normalized; that is, thefrequency values are divided by the total number of samples). As thenumber of samples becomes very large, the histogram tends to anunderlying probability distribution, probability density function (PDF).The PDF can then be used by the system to estimate the statistics of thedevice's latency.

FIG. 4 shows an example of the probability distributions of latency fortwo different devices. One device is connected to the hospital'sinternal Wi-Fi network, and the other on a legacy 2G cellular network.These data have been collected from historical latencies measured duringautomatic sampling. The Wi-Fi connected device has a lower mean latency(5 ms vs. 15 ms), which means that on average it will receive themessage more quickly. It also has a smaller variance (1 ms^2 vs. 25ms^2), which means that its latency is more stable and predictable. TheWi-Fi connected device is expected to have a shorter latency and is thusa better target for a time-sensitive message (all else being equal).

FIG. 5 shows the probability distributions of response time for twodifferent nurses. These data have been collected from historicalresponse times to previous targeted alarms. Nurse A has a lower meanlatency (150 s vs. 200 s), which means that on average s/he will respondto a message more quickly. However, Nurse A has a larger variance (1600s^2 vs. 100 s^2), which means his/her response time is less predictable.Nurse A is expected to respond more quickly to the message, but there isa chance s/he may take much longer to respond. In certain situationsthis may be acceptable. In other situations, a more stable/predictableresponse time may be more desirable than a quicker average responsetime. The system may choose Nurse A or B based on its requirements forthe given message.

The probability distributions can be combined together to arrive at atotal response time distribution. Individual parameters may include thedevice latency given its current location and network connection, theindividual caregiver's innate response time, the caregiver's time sincethe start of his/her shift, the caregiver's current workload, and thetravel time from the caregiver's current location. Probability densityfunctions (PDFs) as shown in FIGS. 4, 5, and 6 can be combined byconvolving them. The convolution operator is a standard mathematicaltechnique known to those skilled in the art, and can easily beimplemented on a computer. For a full treatment of the combinations ofprobability distributions, see e.g. Springer M.D. 1979, “The Algebra ofRandom Variables,” John Wiley & Sons, New York (the contents of whichare incorporated herein by reference).

In some variations, the targeted medical alarm system can be furtherconfigured to track one or more statistics on the individual caregivers,including, for example one or more of:

A. Response times: historical response times to alarm messages can beused to estimate the caregiver latency. This latency can be estimated,for example, as a factor independent of the network infrastructure andmessaging device used.

B. Current location: If real-time location tracking is available, thesystem can be configured to track it.

C. Typical locations: If real-time location tracking is unavailable, thesystem can be configured to use typical assignment locations from thecaregiver's schedule as approximations for expected latencycalculations.

D. Scheduled activities and locations: If a caregiver is assigned todifferent care areas at different times or days, the system can beconfigured to track this information to predict caregiver location.

In some variations, the targeted medical alarm system can be configuredto use feedback from the probe's estimated statistics of the network,devices, and caregivers to intelligently identify one or more recipientsfor each alarm message. For example, when a monitor detects a criticalcondition in a patient that requires an immediate response (e.g.,asystole or ventricular fibrillation), the targeted alarm system can beconfigured to employ, for example, a routing table that can include anescalation path (having, for example, one or more of primary, secondary,tertiary, etc.) caregivers responsible for responding to the alarm toroute the critical message in an efficient way that minimizes deliveryfailure and/or delay. In some variations, the system can be configuredto minimize its routing path to elicit the most rapid response possible.

In some variations, the targeted medical alarm system can be configuredto select (identify) or reject a terminal device/caregiver based onestimated network latency and reliability. For example, the reliabilitymap may indicate that the primary caregiver is in an unreliable branchof the network. The probe map may have this information from, forexample, real-time location tracking, scheduled caregiver activities, orstatistics of historical locations for this particular caregiver. Inresponse, the targeted alarm system can be configured, for example, tore-route the alarm to a secondary caregiver who is more likely toreceive the high priority alarm quickly. This can be repeated, in somevariations, to be re-routed to a tertiary, or additional layers ofcaregivers depending on estimated network latency and reliability. Insome variations, the system can include a threshold value (e.g., maximumlatency permitted) in identifying or rejecting a terminaldevice/caregiver.

FIG. 6 shows an example of process flow in accordance with somevariations of the current subject matter. At 610, the system sends testdata to a terminal device 310. The terminal device is configured togenerate acknowledgement data, including when the test data wasreceived, and send the acknowledgement data to the system (received bythe system at 620). The system determines one or more latency-relatedvalues associated with the test and acknowledgement data at 630, andupdates (e.g., generates and stores) reliability data that are based, atleast in part, on the one or more latency-related values at 640. Whenthe system needs to send a targeted alarm message (e.g., a critical caremessage), the system identifies a targeted terminal device (with anassociated caregiver) for the targeted message at 650, which is based,at least in part, on the reliability data. At 660, the system sends thetargeted message to the identified targeted device.

In some variations, the alarm system can be configured to select(identify) or reject a terminal device/caregiver based on estimateddevice latency and/or reliability. For example, the probe map mayindicate that the primary caregiver's device has a high latency (e.g.,connected to a 2G cellular network). In response, the targeted alarmsystem can be configured to re-route the alarm to a secondary (or atertiary, etc.) caregiver who is more likely to receive the highpriority alarm quickly.

In some variations, the alarm system can be configured to select(identify) the optimum terminal device/caregiver based on thecaregiver's current workload. The scheduling statistics may indicatethat the primary caregiver is currently occupied on another alarm orassigned to a different high priority action, and may be too busy toreact quickly. In response, the targeted alarm system can be configuredto re-route the alarm to the secondary (or tertiary etc.) caregiver whois currently unoccupied, or less busy, and thus able to respond morequickly. In some variations, the system can be configured to send thealarm message to an already-occupied caregiver only if the alarm is ofhigher priority than the caregiver's current task.

In some variations, the alarm system can be configured to select(identify) the optimum caregiver based on, for example, proximity to thepatient needing care. Using the real-time location tracking of allcaregivers, the system can be configured to determine that for example,the tertiary caregiver is in closest proximity to the patient. Proximitymeasures can be, for example, simple linear distances, or can take intoaccount a map of the care area and the travel path required to reach thepatient. In response, the targeted alarm system can be configured tore-route the alarm to the tertiary caregiver (for example) who is ableto respond more quickly.

In some variations, the alarm system can be configured to select(identify) an optimum caregiver based on energy level, estimated fromthe time since the start of the caregiver's shift. For example, thesystem can be configured to record, for example, the number and/or thetype of tasks the caregiver has performed during a particular shift.Based on this information, the system can be configured to route thealarm message to a fresh caregiver at the start of his/her shift (or whohas performed fewer and/or lesser tiring tasks), who is more likely tohave higher energy levels and is more likely to respond quickly to thealarm.

In some variations, the alarm system can be configured to select(identity) an optimum caregiver based on historical response ratesand/or times. For example, the system can be configured to reject aprimary caregiver who often fails to response to alarm messages in thepast (e.g., does not notice his/her phone vibrating), in favor of a moreresponsive secondary caregiver.

In some variations, the system car be configured to maintain a physicaldistribution of caregivers to prepare for unexpected future alarms. Forexample, the system can be configured to keep track of the physicallocations of individual caregivers, and the larger distribution of thecaregiver population. The system can be configured to target the alarmsin such a way as to help ensure the caregivers remain physicallydistributed across care areas. If most caregivers were to becomeconcentrated all in one care area, it would leave some patients more atrisk of a longer response to a critical event.

In some variations, the system can be configured to employ one or more(including all) factors and variations described above, for example,weighing them to identify a target caregiver for sending the alarmmessage. For example, the reliability and/or latency of one or more(including all) elements in the system (e.g., network, device,caregiver) can be combined to estimate the overall reliability andlatency of each caregiver at a given point in time. The system can beconfigured to select (identify) the caregiver with the highestreliability and/or lowest latency at the particular time required forthe particular alarm condition, and routes the alarm message to him/her.

In some variations, the system can be configured to generate a reportincluding one or more of, for example, reliability, latency, and otherstatistics to help identify one or more weak points in the targetedalarming system. Such reports could allow, for example, the hospitaladministration, or technicians, to improve unreliable parts of thenetwork, upgrade terminal devices that do not perform well as alarmrecipients, and device caregiver management strategies to improveschedule, physical distribution, workflow, and more.

One or more aspects or features of the subject matter described hereincan be realized in digital electronic circuitry, integrated circuitry,specially designed application specific integrated circuits (ASICs),field programmable gate arrays (FPGAs) computer hardware, firmware,software, and/or combinations thereof. These various aspects or featurescan include implementation in one or more computer programs that areexecutable and/or interpretable on a programmable system including atleast one programmable processor, which can be special or generalpurpose, coupled to receive data and instructions from, and to transmitdata and instructions to, a storage system, at least one input device,and at least one output device. The programmable system or computingsystem may include clients and servers. A client and server aregenerally remote from each other and typically interact through acommunication network. The relationship of client and server arises byvirtue of computer programs running on the respective computers andhaving a client-server relationship to each other.

These computer programs, which can also be referred to as programs,software, software applications, applications, components, or code,include machine instructions for a programmable processor, and can beimplemented in a high-level procedural language, an object-orientedprogramming language, a functional programming language, a logicalprogramming language, and/or in assembly/machine language. As usedherein, the term “machine-readable medium” refers to any computerprogram product, apparatus and/or device, such as for example magneticdiscs, optical disks, memory, and Programmable Logic Devices (PLDs),used to provide machine instructions and/or data to a programmableprocessor, including a machine-readable medium that receives machineinstructions as a machine-readable signal. The term “machine-readablesignal” refers to any signal used to provide machine instructions and/ordata to a programmable processor. The machine-readable medium can storesuch machine instructions non-transitorily, such as for example as woulda non-transient solid-state memory or a magnetic hard drive or anyequivalent storage medium. The machine-readable medium can alternativelyor additionally store such machine instructions in a transient manner,such as for example as would a processor cache or other random accessmemory associated with one or more physical processor cores.

To provide for interaction with a user, one or more aspects or featuresof the subject matter described herein can be implemented on a computerhaving a display device, such as for example a cathode ray tube (CRT) ora liquid crystal display (LCD) or a light emitting diode (LED) monitorfor displaying information to the user and a keyboard and a pointingdevice, such as for example a mouse or a trackball, by which the usermay provide input to the computer. Other kinds of devices can be used toprovide for interaction with a user as well. For example, feedbackprovided to the user can be any form of sensory feedback, such as forexample visual feedback, auditory feedback, or tactile feedback; andinput from the user may be received in any form, including, but notlimited to, acoustic, speech, or tactile input. Other possible inputdevices include, but are not limited to, touch screens or othertouch-sensitive devices such as single or multi-point resistive orcapacitive trackpads, voice recognition hardware and software, opticalscanners, optical pointers, digital image capture devices and associatedinterpretation software, and the like.

In the descriptions above and in the claims, phrases such as “at leastone of” or “one or more of” may occur followed by a conjunctive list ofelements or features. The term “and/or” may also occur in a list of twoor more elements or features. Unless otherwise implicitly or explicitlycontradicted by the context in which it is used, such a phrase isintended to mean any of the listed elements or features individually orany of the recited elements or features in combination with any of theother recited elements or features. For example, the phrases “at leastone of A and B;” “one or more of A and B;” and “A and/or B” are eachintended to mean “A alone, B alone, or A and B together.” A similarinterpretation is also intended for lists including three or more items,For example, the phrases “at least one of A, B, and C;” “one or more ofA, B, and C;” and “A, B, and/or C” are each intended to mean “A alone, Balone, C alone, A and B together, A and C together, B and C together, orA and B and C together.” In addition, use of the term “based on,” aboveand in the claims is intended to mean, “based at least in part on,” suchthat an unrecited feature or element is also permissible.

The subject matter described herein can be embodied in systems,apparatus, methods, and/or articles depending on the desiredconfiguration. The implementations set forth in the foregoingdescription do no represent all implementations consistent with thesubject matter described herein. Instead, they are merely some examplesconsistent with aspects related to the described subject matter.Although a few variations have been described in detail above, othermodifications or additions are possible. In particular, further featuresand/or variations can be provided in addition to those set forth herein.For example, the implementations described above can be directed tovarious combinations and subcombinations of the disclosed featuresand/or combinations and subcombinations of several further featuresdisclosed above. In addition, the logic flows depicted in theaccompanying figures and/or described herein do not necessarily requirethe particular order shown, or sequential order, to achieve desirableresults. Other implementations may be within the scope of the followingclaims.

What is claimed is:
 1. A targeted medical alarm system comprising: a network adapter configured to communicate with a plurality of terminal devices over one or more networks, each of the terminal devices being associated with a respective caregiver; one or more data processors; and a computer-readable medium storing instructions that when executed by the one or more data processors, performs operations comprising: transmitting test data to each of the terminal devices; receiving acknowledgement data indicating when the test data was received by the respective terminal device; automatically measuring network conditions of the one or more networks by determining, for at least one of the terminal devices, one or more latency-related values associated with each of the test data and the acknowledgement data, the latency-related values including a message latency; automatically updating reliability data based at least in part on the latency-related values including the message latency, the reliability data including at least one of (i) historical latency-related values for the at least one of the terminal devices and (ii) historical response data for a respective caregiver associated with the at least one of the terminal devices, the historical response data including one or more response times of the respective caregiver to one or more previous targeted messages; identifying a targeted terminal device to which a current targeted message is to be sent based at least in part on the updated reliability data including the at least one of (i) the historical latency-related values for the at least one of the terminal devices and (ii) the historical response data for the respective caregiver associated with the at least one of the terminal devices, thereby reducing delay or failure of delivery of the current targeted message; and sending the current targeted message to the targeted terminal device.
 2. A method of targeted medical alarm for implementation by one or more data processors forming part of at least one computing device, the method comprising: transmitting test data to each of a plurality of terminal devices; receiving an automatic acknowledgement from each of the terminal devices indicating when the test data were received; and automatically measuring network conditions of the one or more networks by determining, for at least one of the terminal devices, one or more latency-related values associated with the test data, the latency-related values including a message latency; automatically updating reliability data based at least in part on the latency related values including the message latency, the reliability data including at least one of (i) historical latency-related values for the at least one of the terminal devices and (ii) historical response data for a respective caregiver associated with the at least one of the terminal devices, the historical response data including one or more response times of the respective caregiver to one or more previous targeted messages; identifying a targeted terminal device to which a current targeted message is to be sent based at least in part on the updated reliability data including the at least one of (i) the historical latency-related values for the at least one of the terminal devices and (ii) the historical response data for the respective caregiver associated with the at least one of the terminal devices, thereby reducing delay or failure of delivery of the targeted current message; and sending the current targeted message to the targeted terminal device.
 3. The method according to claim 2, wherein the test data comprises one or more test packets.
 4. The method according to claim 2, wherein the test data is transmitted periodically.
 5. The method according to claim 2, wherein the reliability data comprises a reliability map.
 6. The method according to claim 2, wherein the reliability data includes a current workload data for the respective caregiver associated with the at least one of the terminal devices.
 7. The method according to claim 2, wherein the reliability data includes a proximity data for the respective caregiver associated with the at least one of the terminal devices.
 8. The method according to claim 2, wherein the reliability data includes an energy level data the respective caregiver associated with the at least one of the terminal devices.
 9. The method according to claim 2, wherein the reliability data includes the historical response data for the respective caregiver associated with the at least one of the terminal devices.
 10. The method according to claim 2, wherein the reliability data includes a physical distribution of the respective caregiver associated with the at least one of the terminal devices.
 11. The method according to claim 2, wherein the one or more latency-related values include one or more of: round-trip message latency, a message routing path, and a physical location.
 12. The method according to claim 2, further comprising: receiving a response message from a responsive terminal device; and generating one or more statistics of the responsive terminal device based on the response message.
 13. The method according to claim 12, wherein the one or more statistics include one or more of: a response time, a current location, a typical location, a scheduled activity, and a scheduled location.
 14. The method according to claim 12, wherein the targeted device is determined based at least in part on the one or more statistics of each of the terminal devices.
 15. The method according to claim 2, further comprising: identifying a secondary terminal device based at least in part on the reliability data; and sending the current targeted message to the secondary terminal device.
 16. The method according to claim 15, wherein the secondary terminal device is identified for each critical message.
 17. The method according to claim 2, further comprising generating a report of the reliability data.
 18. The method according to claim 2, wherein the targeted device is determined based at least in part on a location distribution of the terminal devices.
 19. The method according to claim 2, further comprising weighing and combining each of the latency-related values to generate an overall reliability and latency of each of the terminal devices.
 20. The method according to claim 2, further comprising generating the automatic acknowledgement from each of the terminal devices upon receipt of the test data.
 21. A targeted medical alarm system comprising: a network adapter configured to communicate with a plurality of terminal devices over one or more networks, each of the terminal devices being associated with a respective caregiver; one or more data processors; and a computer-readable medium storing instructions that when executed by the one or more data processors, performs operations comprising: transmitting data to each of the terminal devices; receiving acknowledgement data indicating when the transmitted data was received by the respective terminal device; automatically measuring network conditions of the one or more networks by determining, for at least one of the terminal devices, one or more latency-related values associated with each of the transmitted data and the acknowledgement data, the latency-related values including a message latency; automatically updating reliability data based at least in part on the latency-related values including the message latency, the reliability data including at least one of (i) historical latency-related values for the at least one of the terminal devices and (ii) historical response data for a respective caregiver associated with the at least one of the terminal devices, the historical response data including one or more response times of the respective caregiver to one or more previous targeted messages; identifying a targeted terminal device to which a current targeted message is to be sent based at least in part on the updated reliability data including the at least one of (i) the historical latency-related values for the at least one of the terminal devices and (ii) the historical response data for the respective caregiver associated with the at least one of the terminal devices; and sending the current targeted message to the targeted terminal device.
 22. The targeted medical alarm system according to claim 21, wherein the transmitted data includes at least one of test data and actual data.
 23. The targeted medical alarm system according to claim 22, wherein the test data includes one or more test packets.
 24. The targeted medical alarm system according to claim 22, wherein the test data is transmitted periodically.
 25. The targeted medical alarm system according to claim 22, wherein the actual data includes an alarm message.
 26. The targeted medical alarm system according to claim 1, wherein the reliability data includes both of (i) the historical latency-related values for the at least one of the terminal devices and (ii) the historical response data of the respective caregiver associated with the at least one of the terminal devices.
 27. The method according to claim 2, wherein the reliability data includes both of (i) the historical latency-related values for the at least one of the terminal devices and (ii) the historical response data of the respective caregiver associated with the at least one of the terminal devices.
 28. The targeted medical alarm system according to claim 21, wherein the reliability data includes both of (i) the historical latency-related values for the at least one of the terminal devices and (ii) the historical response data of the respective caregiver associated with the at least one of the terminal devices. 